Monday Morning in the ED.. 54 year-old male with palpitations and - PowerPoint PPT Presentation

11/4/2013 Monday Morning in the ED….. 54 year-old male with palpitations and chest pain AF with RVR, rate 155 bpm, BP 89/46 Shocking Revelations in Electrical Management of Dysrhythmias Eric Silman, MD Assistant Residency Director, UCLA/Olive-View EM Residency Ronald Reagan-UCLA Medical Center Monophasic vs. Biphasic Pad Placement Objectives Energy Hands-On Defibrillation 1

11/4/2013 Monophasic Biphasic Monophasic Biphasic Old Technology New Higher Energy Lower More Shocks Fewer More Myocardial Injury Less 2

11/4/2013 Anterolateral Pad Placement Anteroposterior Energy 3

11/4/2013 Ventricular Fibrillation 200 J Energy Atrial Fibrillation 200 J Double Down! You cardiovert your patient… Hands-On Defibrillation Biphasic defibrillator, 200 Joules synchronized Pads placed antero-posteriorly Your tech starts CPR… 4

11/4/2013 Monophasic vs. Biphasic Hands-On Defibrillation Biphasic! Pad Placement Any (VF), Anteroposterior (AF) Worth It? Summary Rationale Energy 200 J* Evidence Hands-On Defibrillation Maybe not References Thank You Botto GL, et. al. External cardioversion of atrial fibrillation: role of paddle position on technical efficacy and energy requirements. Heart. 1999, 82: 726-30 . Freeman K, et. al. Biphasic defibrillation does not improve outcomes compared to monophasic defibrillation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 12 (2):152-6. Link M, et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 122; (18 suppl 3):706-19. Christenson J et al. Chest compression fraction determines survival in patients with outofhospital ventricular fibrillation. Circulation. 2009 Sep 29; 120(13):1241- 7. Lloyd M et. al. Hands-on defibrillation: an analysis of electrical current flow through rescuers in direct contact with patients during biphasic external defibrillation. Circulation. 2008 May 13;117(19):2510-4. esilman@mednet.ucla.edu 5